Acute respiratory distress syndrome after orthotopic liver transplantation
Acute respiratory distress syndrome after orthotopic liver transplantation
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DOI：
10.1016/j.jcrc.2015.09.028
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发表时间：
2016-02-01
影响因子：
3.7
通讯作者：
Xia, Victor W.
中科院分区：
文献类型：
--
作者：
Zhao, Wei;Ge, Xupeng;Xia, Victor W.
目的：急性呼吸窘迫综合征（ARDS）是一种致命的并发症，死亡率很高。本研究的目的是确定原位肝移植（OLT）患者ARDS的发生率、术前和术中危险因素以及ARDS对预后的影响。材料与方法：纳入2004年1月至2013年10月在我中心接受OLT治疗的成人患者。术后ARDS采用柏林定义提出的标准进行判定。多变量logistic模型用于确定ARDS术前和术中危险因素。结果：研究期间1726例患者中，71例（4.1%）发生ARDS。在术前模型中，脑病（优势比[OR]， 2.22; P = 0.022）、术前插管要求（OR, 2.06; P = 0.020）、总胆红素（OR, 1.02; P = 0.003）为独立危险因素。在术中模型中，大的加压剂剂量是ARDS的唯一危险因素（OR, 2.69; P = .001）。术后ARDS患者1年死亡率、机械通气时间和住院时间增加2倍。结论：成年患者OLT后急性呼吸窘迫综合征发生率为4.1%，与术前脑病、插管需求、总胆红素和术中大剂量降压药相关。急性呼吸窘迫综合征与死亡率增加、通气时间延长和住院时间有关。(C) 2015爱思唯尔公司版权所有。
Purpose: Acute respiratory distress syndrome (ARDS) is a devastating complication with substantial mortality. The aims of this study were to identify the incidence, preoperative and intraoperative risk factors, and impact of ARDS on outcomes in patients after orthotopic liver transplantation (OLT).Materials and methods: Adult OLT patients between January 2004 and October 2013 at our center were included. Postoperative ARDS was determined using the criteria proposed by the Berlin Definition. Multivariate logistic models were used to identify preoperative and intraoperative risk factors for ARDS.Results: Of 1726 patients during the study period, 71 (4.1%) developed ARDS. In the preoperative model, encephalopathy (odds ratio [OR], 2.22; P = .022), preoperative requirement of intubation (OR, 2.06; P = .020), and total bilirubin (OR, 1.02; P = .003) were independent risk factors. In the intraoperative model, large pressor bolus was the sole risk factor for ARDS (OR, 2.69; P = .001). Postoperatively, patients with ARDS had a 2-fold increase in 1-year mortality, mechanical ventilation time, and length of hospital stay.Conclusions: Acute respiratory distress syndrome occurred at a rate of 4.1% following OLT in adult patients and was associated with preoperative encephalopathy, requirement of intubation, and total bilirubin and intraoperative large boluses of pressors. Acute respiratory distress syndrome was associated with increased mortality, longer ventilation time, and hospital stay. (C) 2015 Elsevier Inc. All rights reserved.